Cardiac adaptation to pregnancy in women with a history of preeclampsia and a subnormal plasma volume.
In former preeclamptics, a subnormal plasma volume (LPV) predisposes to hemodynamic maladaptation to pregnancy. Here, we assessed the initial cardiovascular response to pregnancy in LPV (n = 20), in former preeclamptics with normal plasma volume (NPV) (n = 35) and in parous controls (CONTR) (n = 9) by echocardiography, blood pressure and heart rate (HR), before pregnancy, and by 5 and 7 weeks amenorrhea. Data analysis was by nonparametric tests. LPV differed from NPV and CONTR, by a consistently lower E/A ratio (ratio of peak mitral flow velocity in early diastole [E] and that during atrial contraction [A]) and an early-pregnancy rise in left atrial diameter (LAD). Both NPV and LPV differed from CONTR by an early-pregnancy rise in HR. The consistently lower E/A ratio together with the early-pregnancy LAD rise in LPV indicate diastolic dysfunction. The early-pregnancy rise in HR suggests sympathetic dominance in the autonomic control of the circulation.
Andrietti
Silvia
S
Department of Obstetrics and Gynecology, University Hospital Maastricht (azM), Maastricht, Netherlands.
Kruse
Arnold-Jan
AJ
Bekkers
Sebastiaan C A M
SC
Sep
Simone
S
Spaanderman
Marc
M
Peeters
Louis L H
LL
D000222:Adaptation, Physiological / Q000502:physiology*; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D020896:Hypovolemia / Q000150:complications / Q000503:physiopathology*; D010953:Plasma Volume / Q000502:physiology; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy / Q000502:physiology*; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology